Perimenopause and Menopause Hormones: Estrogen & Testosterone

Common estrogen-related symptoms

During perimenopause and menopause, lower or unstable estrogen may contribute to:

• Hot flashes and night sweats

• Sleep disruption

• Vaginal dryness or irritation

• Pain with intercourse

• Urinary urgency or recurrent UTIs

• Joint aches

• Skin thinning or dryness

Not every woman experiences all of these, and severity varies widely.

Genitourinary Syndrome of Menopause (GSM)

If this is your first time hearing this term, genitourinary syndrome of menopause (GSM) describes vaginal and urinary changes related to estrogen decline.

GSM can include:

• Vaginal dryness or burning

• Irritation or itching

• Pain with intercourse

• Urinary urgency or frequency

• Recurrent urinary tract infections

This is not a hygiene issue. It is not “just aging.” It reflects real tissue changes driven by hormone signaling.

Local (vaginal) estrogen therapy is commonly used for GSM because it targets the tissue directly with minimal systemic exposure. This distinction is important and often misunderstood.

Progesterone: The Balancing Hormone

Progesterone is often discussed only in relation to protecting the uterine lining when systemic estrogen is used. But progesterone also interacts with the brain and nervous system.

Some women report that progesterone:

• Supports sleep quality

• Has a calming effect

• Helps counter estrogen-related breast tenderness

It’s important to distinguish progesterone from progestins, which are synthetic compounds with different effects and risk profiles.

Testosterone in Women: Clearing Up the Confusion

Testosterone is not a “male-only” hormone. Women produce testosterone throughout life, though in much smaller amounts than men.

What testosterone may influence in women

Testosterone can contribute to:

• Sexual desire and arousal (for some women)

• Sexual comfort and orgasm quality

• Energy and motivation

• Muscle strength when paired with resistance training

• Bone health as part of the overall hormone environment

Testosterone is not a cure-all, and it does not affect every woman the same way.

Why dosing matters

When testosterone is discussed online, the conversation often skips an essential concept: physiologic dosing.

Physiologic dosing means keeping hormone levels within the range a female body would naturally experience. Problems tend to arise when dosing exceeds that range.

Potential side effects of excessive testosterone may include:

• Acne or oily skin

• Unwanted hair growth

• Scalp hair thinning

• Voice changes (rare but important)

• Mood shifts

Precision matters more than intensity.

Why Testosterone Access Is Complicated

In the United States, there is no widely available FDA-approved testosterone product specifically formulated at female doses. Because of this:

• Some clinicians carefully adjust male formulations

• Some women are prescribed compounded products

• Dosing consistency can vary

This is why recent medical discussions—including FDA-level conversations—have emphasized the need for clearer guidance and safer standardization.

The goal is not to push testosterone on everyone. The goal is to improve clarity, safety, and access for women who may benefit.

Systemic vs Local Hormone Therapy

One of the biggest sources of confusion in menopause care is the difference between systemic and local hormone therapy.

Systemic hormone therapy

Systemic estrogen (pills, patches, gels, sprays) circulates throughout the body and may be used for:

• Hot flashes

• Night sweats

• Sleep disruption related to vasomotor symptoms

Systemic therapy requires individualized risk discussion and, in women with a uterus, progesterone protection.

Local hormone therapy

Local (vaginal) estrogen is used primarily for GSM and urinary symptoms. It acts locally on tissue with minimal systemic absorption in many cases.

This distinction is critical. Treating these therapies as identical has contributed to unnecessary fear and under-treatment.

Age, Timing, and Risk Considerations

Hormone therapy is not one-size-fits-all.

Risk considerations may include:

• Personal or family history of hormone-sensitive cancers

• Prior blood clots or clotting disorders

• Cardiovascular health

• Liver disease

• Time since menopause

Many discussions emphasize that starting systemic hormone therapy earlier in the menopause transition may carry a different risk profile than starting much later, but individual assessment always matters.

Hormones and Mental Health in Midlife

Perimenopause is increasingly recognized as a vulnerable window for mood changes.

Hormonal shifts may contribute to:

• Anxiety

• Depressive symptoms

• Irritability

• Brain fog

• Reduced stress tolerance

Hormones are not replacements for mental health care, but for some women, addressing hormonal contributors can be an important part of a comprehensive plan.

What Hormone Therapy Can and Cannot Do

Hormone therapy may help:

• Reduce hot flashes and night sweats

• Improve vaginal and urinary symptoms

• Support sleep disrupted by hormonal shifts

• Reduce fracture risk in some contexts

Hormone therapy is not:

• A guaranteed fix for fatigue or weight gain

• A cure for depression

• An anti-aging solution

• Mandatory for healthy aging

Thoughtful use means clear goals, ongoing reassessment, and respect for individual preferences.

What a Responsible Hormone Conversation Looks Like

A meaningful menopause consultation usually includes:

• Symptom review

• Medical and family history

• Medication review

• Lifestyle context

• Discussion of risks, benefits, and alternatives

Lab testing may be helpful in certain situations, but numbers alone rarely tell the full story—especially during perimenopause.

The Bottom Line

Perimenopause and menopause are normal transitions, but that doesn’t mean women should suffer in silence or navigate misinformation alone.

Estrogen and testosterone influence far more than reproduction. Understanding how these hormones change—and what those changes can affect—allows women to make informed decisions with their clinicians.

At My V Clinic, we believe hormone care should be:

• Evidence-based

• Individualized

• Transparent

• Free from hype and fear

You deserve clarity. You deserve context. And you deserve care that respects both science and lived experience.

FAQs

1. How do I know if I’m in perimenopause?
Irregular cycles, new PMS symptoms, sleep issues, and mood changes in your 40s may suggest perimenopause, even if periods continue.

2. Do hormone levels need to be tested?
Sometimes. In perimenopause, labs can fluctuate widely, so symptoms often guide decisions more than single lab values.

3. Is estrogen safe?
Estrogen can be safe and helpful for many women, but safety depends on formulation, dose, timing, and personal health history.

4. What is GSM?
Genitourinary syndrome of menopause describes vaginal and urinary changes related to estrogen decline.

5. Can vaginal estrogen affect the whole body?
Low-dose vaginal estrogen generally acts locally, with minimal systemic absorption in many women.

6. Is testosterone appropriate for all women?
No. Testosterone may help some women, particularly for sexual concerns, but it is not universally beneficial.

7. Can hormones help with sleep?
They may help if sleep disruption is related to hormonal changes, especially night sweats or progesterone sensitivity.

8. Is hormone therapy preventative medicine?
Hormones may support long-term health in certain contexts, but they are not broadly prescribed solely for prevention.

9. Can I start hormones later in life?
Possibly, but the decision requires careful, individualized risk discussion.

10. What if I choose not to use hormones?
That is a valid choice. Non-hormonal options and lifestyle strategies can also support quality of life.